Facing Death: Breaking the News
September 7, 2009 12:34 PM   Subscribe

Facing death: I have received a medical estimate of dying within a year, but this is known only to me (within my circle of family and friends, including my wife). I am so lost as to how to break the news in a caring, non-stressful way.

I am completely at peace with my fate. I am in my mid-70's and, while I would love to live a few years longer, I have no regrets for the life I have lived and do not feel cheated in any way. I only want to minimize the stress on my family and friends. (I realize this may sound egotistical, but I know they will be quite upset.)

I really dread this--how do I approach it? You can be quite basic in your advice.
posted by potato to Human Relations (36 answers total) 30 users marked this as a favorite
I wish that one day I am at as much peace with my fate as you are today with yours. One important consideration in how you might break this news is your beliefs (and the beliefs of your loved ones). It may make sense to discuss this with your spiritual guides/priests if you are that way inclined.

On a side note, you may want to read about the difficulty medical science has in predicting death and how often it is wrong (in both directions). A good source is 'The Median is not the Message' by Steven J. Gould.

Good luck....
posted by london302 at 12:44 PM on September 7, 2009

Start throwing Going Away parties. When asked who is going away, say that you are. When? Don't know. Then you explain it. Then you get them to focus on the planning and the party, not the finality. Combines explanation with celebration.
posted by seanmpuckett at 12:45 PM on September 7, 2009 [4 favorites]

Start throwing Going Away parties. When asked who is going away, say that you are. When? Don't know. Then you explain it. Then you get them to focus on the planning and the party, not the finality. Combines explanation with celebration.

I'm really not a fan of this idea.
posted by kylej at 12:50 PM on September 7, 2009 [52 favorites]

Plan a trip, if your health will allow it. Tell them beforehand, of course, and don't approach these activities as "the last time..." Enjoy the time you have with your family, and take time to do all the normal things in their daily life.
posted by shinynewnick at 12:54 PM on September 7, 2009

Predicting death is hard, as london302 has pointed out. The author of that essay is actually Stephen Jay Gould (note the spelling); see also his book Full House. The short version of his argument for not taking these estimates too seriously:
- you don't know the distribution of how long people live (and the doctors might not either);
- even if you did your case is not typical;
- these distributions are strongly "skewed", in that some people outlive the estimates by a very long time.
So you very well may have much longer than a year.
posted by madcaptenor at 12:55 PM on September 7, 2009

I only want to minimize the stress on my family and friends. (I realize this may sound egotistical, but I know they will be quite upset.)

They're going to be stressed anyway and that's natural. Just tell them and get it over with, you're running out of time, so you might as well make this last year count.
posted by Brandon Blatcher at 1:06 PM on September 7, 2009 [1 favorite]

I'm a big fan of starting uncomfortable conversations with the truth: "I don't really know a good way to say this, but you're important to me, so I want to tell you..."

I also think if you have some kind of plans you can tell people about, of how you want to handle things, that will help. Something along the lines of, "I don't want to make a big deal out of this, but I do want to make the most of the time I have left, so I'm hoping we can make some time for [dinners/movies/whatever you guys normally do together] in the coming months." Hearing news like this can leave people feeling really helpless, so giving them concrete ideas of things you guys can do together in the next year can be somewhat grounding.

Also, be prepared for the question, "What can we do?" because you're likely to hear it a lot. You might find it helpful to have an answer ready ahead of time, whether it's "can you call to check in on my spouse/daughter/whoever occasionally? I want him/her to have someone other than me to talk to about this?" or "I'm fine for now, but I might get to a point where I would really appreciate a home-cooked meal" or even just "All I need is your love and support."

Good luck through this process. I will be thinking of you.
posted by vytae at 1:08 PM on September 7, 2009 [28 favorites]

Tell them as soon as reasonably possible - as in not when anyone's got a major test or when anyone is, say, filing for divorce. You want to maximize the time you have with them.
posted by kldickson at 1:08 PM on September 7, 2009

Please please please have a Do Not Resusitate/Do Not Intubate discussion with your family and friends (or full medical treatment, if that's what you wish). Get all that information figured out well in advance. Assign your health care proxy. Make sure your advance directive and will area ironclad.

Enjoy your life, spread happiness and love.
posted by ruwan at 1:12 PM on September 7, 2009 [5 favorites]

I'm confused -- you have not told your wife or any close friends? If I were your wife or close friend, I would want to know and would be annoyed/mad if you didn't tell me. Most humans who live a long life will have the experience of knowing someone with a life-ending illness and then death. It's a human experience. Upset is fine and a normal reaction. People then adjust, or not, it's part of life and death. It's like any big news -- sit each person down individually and say, "I want to let you know something my doctor recently told me. It's not set in stone, but it looks like I have limited time left." (I disagree with anyone who suggests not to tell at all.)
posted by ClaudiaCenter at 1:13 PM on September 7, 2009 [2 favorites]

This is not advice, just a data point. If I were close to you, I would prefer the stress of knowing this diagnosis to the alternative of ignorance. When you are gone, I believe those people will be glad that you shared this information and that they were able to stand by you and appreciate this time while it's here. I would.

As far as the methods, I would prefer that a loved one tell me directly, without a lot of other people present, so I can react and process with him in my own way. I would very much want to hear that you feel happy about the time you've had and how you've lived your life. And, perhaps most importantly, I would like to know what now? How do you plan to spend the time you have, and how would you like me to be a part of it?

I have no idea how you family and friends will react, but in your gut you probably know what's best for them. I respect your desire to help them through this. I hope they can give you the same gift you're so willing to give them.
posted by itstheclamsname at 1:16 PM on September 7, 2009 [2 favorites]

I would like to hear from someone that "I have {disease}, and the doctors have given me {estimate}. I want you to know this, not because I want you to worry or feel bad, but because you are important in my life and I want us to make the best of the time we have together. And who knows? I could get hit by a bus tomorrow, or have longer than the doctors think--I just want you to know that I have received this significant news."

That's what I'd like to hear. My much-loved uncle told us about a cancer diagnosis that looked bad for him--he then had successful surgery and thought things were on the mend, but died suddenly from another issue. If he hadn't called with the news of the cancer diagnosis, I wouldn't have had the chance to tell him so clearly how much I loved him and had valued his advice and support throughout the years. That meant a lot to me.
posted by Sidhedevil at 1:29 PM on September 7, 2009 [26 favorites]

I agree with the advice to be as direct as possible: "Honey, I have some bad news."

One thing which is worth mentioning is that the people you tell may have all sorts of weird reactions which are all about them and their feelings about this. People are not going to come right out and say "Help me with my feeling about your illness" but they might very well act like that.

Good luck.
posted by shothotbot at 1:54 PM on September 7, 2009

Of course they will be quite upset. Allow them to grieve and to celebrate you.

I've been on the receiving end of this talk. It started slowly, so that I really knew what was going to be said before the words were spoken. It was something like this: "I have some bad news. [pause] I went to the doctor today. [pause] He said the medicine isn't working. [pause; this is where I really understood what was going on.] He said I should have 6 months [obviously, 12 in your case] or so to live."

I am so glad that we did have that conversation as soon as we did; it gave me time. I'm also glad that it was at home, and in my case just with my immediate family, because I kinda lost it. I'm also glad that in the days and weeks following that discussion, we had many talks about our fears and our feelings.

This is going to be a tough discussion, but you sound like a very brave and caring person. Telling them in a straightforward fashion, without glossing it up any, and telling them right away, is the right thing. They will be upset, because they love you. You can't protect them from that, because their being upset is a part of loving you.
posted by Houstonian at 1:55 PM on September 7, 2009

We recently went through a very similar situation with my father. He had always been everyone's rock, and he didn't want to upset us. He finally confided in me, and I'll tell you what I told him: You are not responsible for anyone's reaction to the news. People are going to want to know because they love you. They are going to be upset because they love you. The best way you can help them deal with it is by being honest and sharing this with them.

Only you will know the best approach to take with each person you tell, but he fact that you are at peace with it will help. I wish you all the best!
posted by gimli at 2:03 PM on September 7, 2009 [2 favorites]

Have you considered seeing a therapist that has experience in these matters?
posted by jchaw at 2:03 PM on September 7, 2009

While I understand the urge to not worry others, I think that people close to you would appreciate the information and the time to deal with it in their own ways.

I don't think you have an obligation to tell them, necessarily, but I think that they would rather know.

In my experience, my grandmother downplayed the return of her illness, which in turn led to her children being shocked when they realized how serious things were. They would have been sad if they know, but now, I think they have some regrets, because they acted in ways that reflected an incorrect belief that they had more time.

"I'm sorry you have to deal with this, but I also think that Sidhedevil has good phrasing. Basically, here's the deal, nothing's certain, but I'm telling you because I love you and don't want you to be surprised."
posted by mercredi at 2:05 PM on September 7, 2009

I am completely at peace with my fate… I have no regrets for the life I have lived and do not feel cheated in any way
When my grandfather died, we were all able to take comfort in the fact that he had said that he was at peace with the idea of dying. Even though he thought he was going to meet God and everyone else in the family is an atheist it still made it a lot easier for us. So whatever else you decide to do and say, this will help your friends and family immeasurably.
posted by nowonmai at 2:26 PM on September 7, 2009 [1 favorite]

The amount of love you obviously have for your family and friends, to be so concerned for them at this time, leads me to believe that you'll do well just sitting down one-on-one with them. Good luck and take care!
posted by orme at 2:26 PM on September 7, 2009

Although we are not a family that shares a lot of stuff, when my dad -- in his early 70s -- found out in Jan. 2007 that he had stage IV bladder cancer, he told his wife immediately and within a couple of weeks he called all of his daughters to tell us (he was in Fla. at the time, far from all of us). It was a hard conversation, he broke down and wept when he was telling me, there were a lot of unknowns facing us all across the phone lines ... The diagnosis was dire.

But -- I am so glad he told us and told us soon. I decided to visit him before his first surgery, taking the train to Florida to spend a full week talking, walking, hiking and enjoying time with him. He invited questions about his illness, about mortality, about unresolved places in our relationship, about life in general. (Yes, he is a special man.)

He had already done his health directives and Will. Soon after he got his diagnosis, he wrote his own obituary for us so we wouldn't have to do that while freshly grieving. Now it's almost three years later, surgery and chemo over for now, the cancer metastasized more than a year ago to small nodes in his lungs, and he's still with us on the Earth, still feeling well, taking trips overseas to hike, still hiking several days a week and doing work hikes every week.

I don't know when he will die, and neither does he, but I am glad to have had that week of intense and yet ordinary time with him, when he was so willing to be vulnerable and open. I'm also glad he is living every day the way he wants, and I wish the same for you as long as possible.
posted by mmw at 2:40 PM on September 7, 2009 [12 favorites]

Be prepared for people to try to challenge you on this. To want you to get third and fourth opinions, to try this or that remedy, to go to X medical center. Your acceptance of the situation will be troubling to some people. Be ready for it.

Talk to the people closest to you about the end outcome, because they need to know and you need for them to know. But you will likely forestall some unwanted encouragement/advice by not telling too much to more peripheral people.

Blessings to you as you go through this hard time.
posted by SLC Mom at 2:49 PM on September 7, 2009 [1 favorite]

First, I am sorry to hear about your news, Potato. It is good to know that you are at peace with it though. This is the most important part for you and everyone who loves you.

My mother often tells me that she wants people to tell jokes and sing at her funeral, so that it's not a sad, dark affair as she has seen too many times at loved ones' funerals. I tell her the same thing I will tell you now - you can't control how other people will react or behave to your death (or to anything else, for that matter). Grieving is one of the most natural processes. In your case, your family will just start grieving while you are still alive.

In this instance, remember it is your choice what exactly you tell them. Your passing will not be any harder or easier whether they know in advance or not. Do you want them to know so that they can spend more time with you? Or so you can console them in advance? If so, certainly tell them. But the shock and the stress, as well as their own grieving, can't be helped or controlled. Good luck, and please take care of yourself.
posted by SassHat at 2:55 PM on September 7, 2009

As many have said, your family and friends will be upset, but you can't control their reactions. What you can do is tell them that you love them, and that doctors don't ever have an exact prediction of when someone will die, but you have received this estimate and you'd like to [insert whatever it is you'd like to do, like spend time with them, etc.].

My father received an estimate like this last year. He was told he had four weeks to live. Our family was considerably upset, as one might expect. (We had no idea he was sick at all until the terminal diagnosis.) He came to terms with it, wrote his own obituary, got his health care proxy & will all set up, and even arranged his own funeral. Though it was all very upsetting, hearing from him that he was at peace with his situation and happy with his life was very comforting to me.

That was last September, and he is not only still alive, he is feeling fantastic. So, the estimates are just that - estimates. And when he does eventually pass, I'll be happy that I got to spend all of this time with him, doing things that make him happy.
posted by bedhead at 3:28 PM on September 7, 2009

Please tell your wife as soon as possible. Help her get through the initial period of being upset, then let her help you tell the others. My sympathy to both of you, and I hope it goes as well as it can and you have more time left than the doctors think.
posted by languagehat at 3:36 PM on September 7, 2009

My parents were both taken from me in a split-second. I have lots of questions I'll never have answered - how they felt about their lives, death and so on. Losing both at once made many aspects of their lives even more mysterious. I'd give almost anything to have just an hour to ask questions, tell them how I felt about them, and so on. The thought that I might have a whole year with them before their deaths seems like a fantasy to me, no matter how hard losing them would be. So my advice is just to tell them, ASAP, in any way you can. Blurt it out at the dinner table or while watching television. It really doesn't matter, and people will react in such varied ways that a sense of etiquette in the matter is just pointless.

BUT tell your wife first though, and let her work through it. We'll all pass away, but this is still sad news. Please take care.
posted by Dee Xtrovert at 3:56 PM on September 7, 2009 [1 favorite]

Julian Barnes' excellent book Nothing to be Scared Of has a section that would be very relevant to you.
posted by The corpse in the library at 4:22 PM on September 7, 2009

I am completely at peace with my fate. I am in my mid-70's and, while I would love to live a few years longer, I have no regrets for the life I have lived and do not feel cheated in any way.

Tell your loved ones this when you break the news. Perhaps verbatim. It will probably bring some comfort to your family and friends to know that you're not angry, remorseful, or afraid about this - that you're walking into this calmly, with clear eyes and your head held high. Then again, it's understandable if you're freaking out on some level, and you don't need to be stoic all the time, but a "hey, I'm okay with this" can go a long way towards calming your friends down.

(This was how my dad went - he passed earlier this year after a year-long battle with cancer - and he was so brave, calm, open-minded even at the end, and I am so very grateful that my last memories of him were of him at his strongest.)

This goes without saying, but tell your friends and family you love them. Thank them for being a part of your life; tell them you're proud of them, you believe in them, or whatever you feel/believe about them or whatever about them has made your life better ("I love you because ________").

It's wonderful of you to be thinking of your family and friends at a time like this; I wish you and yours courage, strength, and peace as you go through this together.
posted by Metroid Baby at 4:49 PM on September 7, 2009 [3 favorites]

It sounds like you have two responsibilities in telling your close family: To get them emotionally prepared and to get them materially prepared. The first has been well-discussed above; giving people time to come to terms with the news is stressful and hard to take, but it is also compassionate. To do otherwise only delays that stress and may magnify it. The second is also important: If, for example, you have wishes regarding palliative care or end of life processes (such as a do-not-resuscitate request), get done whatever paperwork is necessary and make your decisions known; the point at which you are no longer of sound mind is the point at which people will do the wrong things out of good intentions, leading to even more stress for everybody concerned. If you get better -- or the inevitable is indefinitely postponed -- none of this work is wasted.

This is sad, heavy news, man. But getting the worst over with now can give you more time and less stress for the remaining days with the people you love.
posted by ardgedee at 4:52 PM on September 7, 2009

potato, I am sure I don't have to tell you that your family and friends will definitely argue with you to "fight" for your life. Here in the U.S. (well, elsewhere too--) we have an almost ridiculous beyond-the-pale attitude about challenging death. Most everyone finds dying to be a next to impossible thing to discuss reasonably.

You shouldn't candy coat things for your folks--but if you give it to them with both barrels they are going to take it harder than they need to. Just tell them what your doctor said and let them be mad and sad and feel all the feelings they will feel. ...and then (this is important) tell them you're in no hurry to go anywhere...but that you're not worried.

I know you will do great. Your family is fortunate that you wish to include them in the transition. We are all continually in some phase of coming and going.
Thinking of you, potato!
posted by naplesyellow at 6:21 PM on September 7, 2009

As someone's daughter and someone's granddaughter, I can tell you that what you said is exactly what I would want to hear - that you are at peace, have lived a wonderful life, and have no regrets; also, that you just wish to spend your last year enjoying life as you're used to, and continuing to enjoy the moments with your loved ones. Urge them to please believe that this is the case, and that what they can do for you is to continue living and treating you as usual.
posted by namesarehard at 6:26 PM on September 7, 2009

Response by poster: I cannot believe the outpouring of tender, thoughtful comments I have received from anonymous strangers. There is much here to help me and I will take it all to heart. The overriding sense is to be candid, straightforward and prompt, which I will do.

(I might note that my wife and I made Enduring Power of Attorney and very detailed Advanced Directives--signed by all offspring--some time ago.)

I have to admit that in my early life I was very closed and somewhat secretive. Fortunately, through living with a very loving, supportive wife and family, those days are over and I have learned how important it is to be open and lovingly interactive.

God bless you all.
posted by potato at 7:06 PM on September 7, 2009 [2 favorites]

Potato... this is a tough nut for you. There are many ways you have to look at this situation. So many so it is impossible to comprehend. The story of your fate is going to effect different people in your life different ways. That said, there is no correct answer. What you have to come to grips with is "what is right for you". The only problem is you have never been in such a position and have no experience to fall back on.

So the question begs- what do you say and how do you say it? My Mom got breast cancer. The docs laid it on us pretty hard. There were a lot of positive nodes in bad places- outlook not good. Mom approached it by telling us regardless of what anyone says nobody and can tell you for sure when your number is up. So, her statement was- I am sick but I want to get better. I could leave this hospital tomorrow and get hit by a bus. I will let the chips fall where they may and take each day one at a time... just like we all do each and every day. Who knows, they could come up with a new treatment and things could change.

That was 18 years ago.

She was diagnosed with bone cancer last year. We all gathered around the kitchen and she broke the news and concluded the statement with "tomorrow was another day and things could change in a blink of the eye." I could, and am, living with that. This statement of her reality was enough for me.

You have to dole out the bad news but you can always conclude your statement with a ray of hope, no matter how slim, that things could change for the better. Miracles and science can change reality pretty fast. Cling to that, live your live as best you can and give yourself and others the hope, no matter how small, that things might get better.

It is tough for me to conclude this post as I now know your news. If I was there I'd give you a high five and a smile. Best of luck to you and yours.
posted by bkeene12 at 8:12 PM on September 7, 2009

The first answer to this post contains a reference to an essay which I think is invaluable to anyone in this position: Gould's The Median is not the Message
posted by Neiltupper at 8:50 PM on September 7, 2009 [1 favorite]

Potato, I agree with the advice you've received. My mother didn't get to choose how to tell me about her cancer; I was with her when she got her diagnosis. But I was glad to know as soon as possible (about a year before her death), and also to know she was ready to go. I have many wonderful memories from that last year. I imagine that a few years from now, your family and friends will be able to say something very similar.

The only bit of advice I can think of adding is to review all your legal papers, since you say they were done some time ago; make sure that nothing has changed.

Best wishes to you and yours.
posted by jeri at 3:08 AM on September 8, 2009

My father is about your age--I'm thinking about what I would want to hear from him. After the initial shock, my first thought would be "what can I do?" Obviously "cheat death" would be my most-wished-for answer, but since that's not going to happen, maybe you can come up with something else?

If you could think of something that each person close to you could do, I bet that would help them feel useful and positive about something that will also be very sad. Also, this would make things more activity-oriented, since you don't really seem like the type of person who wants to spend your last days comforting your weeping friends and relatives.

"I don't want to tell the Mr. and Mrs. XYZs about this myself, but I want them to know. Would you mind giving them a call?"
"I want you to organize a nice family dinner for Thanksgiving."
"Can you take me on a hike around the lake next month sometime?"
"I want there to be a nice slide show at my memorial, and I was wondering if you could put it together, and if if I could get a look at it while you're working on it."
"I think it would be nice to record some memories I have of my childhood. Could you come up with some questions and record me speaking?"
"My office is kind of a mess, and I don't want to leave that for my wife. Could you spend a couple of Saturdays helping me go through it and throw things out?"

Basically, nice, bonding activities that involve positive memories.

Good luck with this last year(?) of your life. It sounds like you are approaching it with as good an attitude as any human being can be expected to have.
posted by tk at 6:24 AM on September 8, 2009 [2 favorites]

Any chance on a follow up?
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